Dr. Strangegait, Or How I Learned to Stop Worrying and Love Hip Extension

Matt Hsu is a Certified Rolfer and certified Egoscue Posture Alignment Specialist in San Diego, CA. He co-teaches Seeing Made Easy, a class designed to help structural integrators make accurate assessments, formulate effective intervention strategies, and become better resources for their clients. More information is available at http://seeingmadeeasy.com. When not working with clients, Matt is an active part of the local ice hockey community and has the stitches to prove it.
Author
Translator
Pages: 13-16
Year: 2011
Dr. Ida Rolf Institute

Structural Integration – Vol. 39 – Nº 1

Volume: 39
Matt Hsu is a Certified Rolfer and certified Egoscue Posture Alignment Specialist in San Diego, CA. He co-teaches Seeing Made Easy, a class designed to help structural integrators make accurate assessments, formulate effective intervention strategies, and become better resources for their clients. More information is available at http://seeingmadeeasy.com. When not working with clients, Matt is an active part of the local ice hockey community and has the stitches to prove it.

Matt Hsu is a Certified Rolfer and certified Egoscue Posture Alignment Specialist in San Diego, CA. He co-teaches Seeing Made Easy, a class designed to help structural integrators make accurate assessments, formulate effective intervention strategies, and become better resources for their clients. More information is available at http://seeingmadeeasy.com. When not working with clients, Matt is an active part of the local ice hockey community and has the stitches to prove it.</i>

I spent many an evening with classmates at the Rolf Institute® walking down Pearl Street in Boulder, making “Rolferesque” remarks about people’s supinated and everted feet, hunched shoulders, and wonky knees. But beyond being able to see those quirks of people’s gait, we weren’t able to talk in detail about what was going on and, more importantly, what to do about it. This article’s goal is to give you a quick overview of why gait is important, why we should break it down and analyze its parts, what to look for in a client’s gait, and how to begin to understand why someone’s gait is the way it is.

 

Why Gait Is Important

Gait tells us about the functional ability of the entire structure. It tells us what the body can and cannot do. Knowing that a body will conserve as much energy as it can in motion, we look for dysfunctions that cause the body to work inefficiently (i.e. in ways that put excess wear and tear on the body). If we can address these dysfunctions, we can improve a client’s sense of well-being and integration.

Before anything else, we should recognize that every individual’s gait is unique. Even two fully functional people would have different gaits based on their own emotional and physical predispositions. No two people walk alike (unless one is a particularly skilled ninja deliberately mimicking the gait of the other). This helps our brains not only identify different people but also identify specific traits about different people.

In other words, we look for quirks to identify people’s moods, motivations, and states of health. For example, we all know that the way a woman moves her body tells you something about her internal state. If she’s got her arms crossed, tapping her foot, chin up, and her brow is furrowed, you are probably late for date night. In this case, we are looking at moods and motivations. If a man is unable to get his shoulders back where they belong, if his pelvis is stuck in a tuck, if his head juts out like a piece of a Liebeskind building, and he’s telling you that he suffers from constant fatigue, pain, and stiffness, then we’re talking about health. We are talking about functions and dysfunctions that affect the way this man feels physically.

Dysfunctions are deviations from normal biomechanical average potentials for movement – abnormal range of motion and usage of joints. We are looking for the things that cause pain, discomfort, and dis-integration in our clients’ bodies. A functional glenohumeral joint, for example, should be able to get 90 degrees of abduction with no problem. We’ve all seen the glenohumeral joints that get to only 60 degrees before pain sets in. That’s a dysfunctional glenohumeral joint. If the left quadratus lumborum contracts to sidebend the trunk and elevate the arm to create the illusion of abduction, we then have a compensatory movement.

When we look at gait, we are looking for similar red flags. We want to know a functional hip from a dysfunctional hip from a compensating hip. We want to know a functional shoulder from a dysfunctional shoulder and how it relates to a possibly compensating pelvis. We need to know these things to be able to bolster our abilities to make speedy, intuitive, well-grounded judgments in our practices.

 

Intuitive Gait Analysis in the Real World

If a small, scrawny guy comes limping at you, it’s not nearly as threatening as a big burly guy bounding at you with six-foot strides and a set of bulbous and welldefined arms punctuated with clenched fists. The former is clearly and immediately preferable to the latter. No careful analysis is required because your intuitive sense, based on years of experience, tells you that the latter character is a serious threat to the integrity of your body and life. The former is someone you may be able to simply sidestep.

Let’s look at another example. From a distance, you can very easily spot someone walking with a freshly sprained ankle. Even as a child, you were likely able to see when a friend or family member had a sprained ankle, even if he or she wasn’t using a crutch. There is a telltale limp that alerts you to something being wrong somewhere in that person’s body. Intuition is a handy tool for analyzing gait in these cases; but for many clients, this level of intuitive understanding isn’t enough to help them really change their bodies for the better. Worse still, relying on this basic intuitive sense for more complex gait patterns may completely mislead us into thinking that many gait patterns are perfectly functional.

<i>Recently, a video shot from a trolley car traveling down San Francisco’s Market Street at the turn of the 20th century surfaced online and circulated through the Rolf Forum email list. The video (www.youtube.com/watch?v=NINOxRxze9k) shows an incredible amount of good posture and good gait. What you see today, in comparison, is astounding: the “normal” that’s out there on Pearl Street in Boulder (a fairly active and athletic community) is pretty darn dysfunctional.</i>

 

Why Intuition Is Not Enough

 

Intuition, as a growing body of brain research tells us, is the shorthand syntheses of what we know, have experienced, and have imagined or extrapolated. In any given moment of decision or observation, we are taking a mass of data in our brains that would take about six years to catalogue and analyze and distilling it into a lightningfast response requiring no deep analysis. It’s a very handy tool, but it is by no means perfect, particularly when looking at gait.

As society becomes more technologically advanced and more chair-dependent, it’s getting harder and harder to get a good intuitive gauge on what good structure and posture really looks like. As modern sitting life foists abnormal structure and gait on a shocking majority of the population, our brains have a harder time measuring bodies in front of us against a truly functionally normal gait (or even static standing posture for that matter). Instead, our minds become numb to the very common rounded shoulders, gorilla hands, pelvic rotations and elevations, and deactivated hip muscles that create gaits filled with strong compensatory motions.

We are also plied everyday with truisms about the body like “always bend at the knees because backs are bad at lifting,” “your posture is genetically determined,” “your clavicles sometimes grow too long and impinge on nerves,” and – my favorite – “flat feet are of no consequence.” These truisms normalize and discount the effects of chronic and progressive deterioration of one’s posture, making it difficult for everyone to see clearly what declining posture tell us. This difficulty arises for our clients (e.g. “I always figured this limp was genetic since my dad also limps”), and it can happen with Rolfers (e.g. “Your kyphosis is as good as it’s going to get because it’s part of your pattern.”)

So let’s look at a very clear example of a gait with dysfunctions: a limping man with shoulder pain. On first examination, we’ll notice he looks slow and has that sense of “drag” about him. We can tell something’s going on with his leg. His gait pattern so clearly deviates from what a normal walk looks like that most people with no professional training at all can figure out in a quarter second that he has a foot or ankle issue. But what does it have to do with shoulder pain? If we break things down to more detail, we’ll notice things in a way that can help us to guide him to a better understanding of his shoulder pain.

We might notice that the hip freezes in 30 degrees of flexion, and the knee stays bent to keep weight from going into the immobilized ankle. His head juts forward, and, with each step, the shoulder and torso rotate in the transverse plane to get extra forward momentum. He rotates asymmetrically. One of the scapulae sits in constant protraction. This is the side where he feels pain in the area where his trapezius resides. On palpation, you can feel the hard, dense, inflamed feeling that tells you some soft tissues are working too hard. You now need only determine what it’s going to take – globally – to get the shoulder complex moving the way it should to reduce the pain in the shoulder.

 

Functional Gait

For an in-depth view of gait, I recommend the book <i>Observational Gait Analysis</i> from the Pathokinesiology Service and the Physical Therapy Department at Rancho Los Amigos National Rehabilitation Center. It’s very detailed and helps you mentally break down the different phases of a gait so that you can develop a more thorough understanding of the intuitive sense of “huh?” that you get when you see someone with a quirky gait.

Let’s see what a functional gait looks like. After a quick, simplified explanation, we’ll look at a quick assessment tool you can use to begin to figure out what’s going on with someone’s gait and how you can start your work with him.

 

Here are our two basic points when looking at gait:

 

  1. A functional gait is symmetrical: From the anterior and posterior views, you should not see shoulders drooping to one side, elevation of a hip, asymmetrical rotation of the hips in the transverse plane (or much transverse plane rotation for that matter, as will be clarified later), or asymmetrical arm swing. Feet and knees should be tracking mostly in the sagittal plane. If the knees and feet are always laterally or medially rotated, there is a dysfunction.

 

  1. A functional gait provides smooth pull and push: From the side view, watch one leg. It should swing forward in the air and land on the heel as the knee extends. The hip joint should extend to about 20 degrees as the body’s weight comes onto the toes. At that point the hip joint flexes, the knee flexes, and the forward swing begins. When the left foot is forward, the right hand and arm swing forward (contralaterally) without a significant amount of rotation or flexion of the upper body. The chest should remain up, the shoulders back (so that you see mostly shoulder and chest as opposed to scapula and shoulder), and the head level (see Figure 1).

 

<i>Figure 1: Correct gait posture.</i>

 

A great many modern walks lack real hip extension. Without that, any significant forward push off the back foot is impossible. Common compensations include trunks flexed forward and/or rotating and pelvises rotating in the transverse plane in an attempt to elicit forward momentum (see Figure 2).

<i>Figure 2: Compensation pattern.</i>

 

None of those compensations are great for the long term (inefficient energy expenditure and lots of myofascial compensations that will eventually become range-of-motion and pain issues of their own).

Being able to see deviations from proper gait helps you understand not only the pain your client reports, but also where to start looking to make some big changes.

 

A Functional Test to Identify Dysfunction

Here is a general test from Egoscue® posture alignment therapy that is extremely useful for building an understanding of your clients’ structures. It will help you differentiate the deep-rooted dysfunctions from the compensations that will unravel once you’ve dealt with the dysfunctions. It’s called the Hands-On-Head test, and it’s a fantastic sleuthing and client-education tool. It helps you determine how much of a role the shoulder girdle and thoracic flexion are playing in what’s happening in the pelvic girdle and the range of motion in the hip joints in gait.

Let’s say you have someone come in who, from the A/P view, has an asymmetrical transverse plane rotation in the pelvic girdle (left ilium stays more anterior than right ilium), a left knee and foot that stay laterally rotated throughout most of the gait, a slight trunk lean to the left (abduction of left hip joint and adduction at right hip), a trunk that is slightly flexed, shoulders that are rounded forward, and forward-head posture (see Figure 3).

<i>Figure 3: Pre-test pattern.</i>

 

To start the test, you need a baseline to make a comparison. Therefore, have your client walk back and forth. Ask questions about how things feel, how his weight is being distributed, how the bra strap feels as she’s walking, whether his shoulders feel or look even, etc.

This is a very easy process for clients with a good kinesthetic sense. Often, the kinesthetically aware client will tell you that he feels like he’s leaning to the right, that his legs aren’t doing the same thing (e.g., it’s almost as if one leg is longer than the other), that he feels like he’s slouching, and that some body part or segment feels like it’s taking on lots of strain. That is your baseline.

If you get a more visually oriented client, you’re going to need a mirror or be very comfortable taking videos and showing them to your client. If you don’t already have it at your disposal in your office, I’d recommend having a full-length mirror with a decent amount of open distance in front of it so that your client can walk in front of it. With the mirror, she’ll be able to spot what’s going on. You may need to cue her for landmarks to watch and compare as she’s walking. Remember, she’s probably never done this before. Break it down using some of the information you now know about proper gait. Have her watch knees, feet, hips, shoulders, or any other bony landmark that appears to be relevant.

If the client is not kinesthetically in-touch and can’t really see what you’re talking about, she may be more auditory oriented, in which case you can try cueing her in to the sound of her gait or the internal sound of the impact of her joints or body segments. Failing that, you may just have to start telling her what you see.

Now that you have your baseline (make sure you take notes so you don’t forget what you saw), you’re ready to do the test. In Seeing Made Easy (the workshop I co-teach with Isaac Osborne), we talk about this as a very useful alternative to the “crest test” of the eighth session of the Rolfing® Structural Integration Ten Series, as it shows you whether working on the shoulder girdle or the pelvic girdle will have a more significant effect.

 

  1. Have your client interlace his fingers (see Figure 4).

<i>Figure 4: Interlocking fingers.</i>

 

  1. Have your client put his palms on the back of his head and pull his elbows posteriorly (see Figure 5).

<i>Figure 5: Pre-test position.</i>

 

  1. Have your client walk again while maintaining the hand and elbow positioning.

Observe what difference this makes to the client’s gait. Is there is a noticeable or significant change in the gait that you or your client feels, sees, or hears? If so, you know you have a pretty significant relationship between the shoulder girdle positioning, the thoracic spine flexion, and the pelvic girdle. It means that for this particular client, the dysfunctions in the upper body are causing the lower body to compensate in significant ways while in motion (and very likely while standing still).

For kinesthetic clients, this can be a revelation on par with the introduction of the iPhone. The obviousness of the connection between the upper body and lower body will literally change their understanding of their pain. I’ve had people with sciatica who were absolutely “gobsmacked” by the fact that their nerve pain suddenly decreased by doing this simple test (and could be aggravated by dropping their arms again). This is a huge educational piece that demonstrates the beautiful ways in which the human body can accommodate and adapt to varying dysfunctions.

For a visual client, that mirror will come in handy. Have him compare and contrast the walk in front of the mirror. If the knee and foot no longer rotate laterally as much (or at all), you have yourself a great sign. If the pelvis stops rotating the way it was, you have a good sign. Those are things your client will be able to see and tell you. Just make sure you ask him questions to get him to pay attention to those things. Again, once he sees the difference, you’ve helped him discover something priceless.

For auditory clients, the sound of foot fall might sound more even, and that’ll be a great victory. Otherwise, you may just have to tell them what you see changing and be okay with that.

 

Understanding the Hands-On-Head Test

When you have the client position the hands and elbows behind the head, you’re requiring some thoracic extension and scapular retraction/stabilization. This gives you and your client the chance to see what effect improved shoulder girdle stabilization will have on the body below. Again, if there is improvement in the lower body, you have a positive sign that shoulder-girdle work will give you big bang for the buck – whether you’re working in the Ten Series or going non-formulaic. Congratulations, you just saved some sweat on your brow and skin from your knuckles and elbows! You’ll probably still have to spend time on the pelvis (as it’s almost certainly not going to just mend itself right back to perfect function without some nudging in the right direction), but you’ll be working much more efficiently.

If doing the Hands-On-Head test doesn’t change the gait, then you know that whatever the dysfunctions of the shoulder girdle and thoracic spine may be, the ones in the pelvic girdle are not going away by just working on the upper body. That may be no fun, but at least you’re now armed with some knowledge that will help you make informed decisions about the relationship between the pelvic and shoulder girdles and how to proceed with the planning of your sessions.

Further functional tests can then help you assess to what extent the pelvic girdle is responsible for the shoulder girdle’s issues. This exploratory process with your client helps her understand the value of seeing the body as an integrated unit and helps you train your analytical and intuitive brains. And it all starts with a little walk in your office.

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